LASER Applications for
Skin Rejuvenation
Dr. Tzermias Christopher
Athens
Greece
1
LASER Applications for
Skin Rejuvenation
Traditional rejuvenation techniques
(CO2, Er:YAG) characterized
by top–to–bottom injuries,
sacrifice epidermis to achieve
subsequent dermal remodeling.
2
Ablative LASERs Produce:
Epidermal Ablation:
• Improvement in skin surface texture
and dyspigmentation but
• Prolonged healing time
• High incidence of complications
Dermal Injury Thermal Contraction:
• Immediate collagen denaturation and
shrinkage
• Collagen remodeling
• Wrinkle improvement
3
Ablative LASERs for
Skin Rejuvenation
• The primary mechanism for wrinkle reduction
after laser resurfasing appears to be a
dermal wound and new collagen formation.
Therefore, is epidermal ablation really
necessary for skin rejuvenation?
• Theoretically, techniques that induce a
dermal wound should lead to cosmetic
improvement.
4
Non – Ablative LASERs
For Skin Rejuvenation
“Selective dermal remodeling”
theoretically can be accomplished by:
Deeply penetrating laser beam
• Dermal Heating
• New Collagen Production
• Cosmetic Enhancement
Surface – Cooling Device
• Epidermal Preservation
5
Non – Ablative
“Subsurface Remodeling”
has been reported to be induced by:
Pulsed – Dye Laser
(P.Bjerriug et al, J. Cutaneous laser therapy,2000,2:9-15)
1320 nm - Nd : Yag Laser
(D.J. Goldberg, Dermatol. Surg. 2000, 26 : 915-918)
1450 nm - Diode Laser
(D.J. Goldberg, Lasers in Syrg and Med, 2000, 26:196-200)
Intense Pulsed Light
(D.J. Goldberg, K.B. Culter, Lasers in Surg. And Med, 2000,26:196-200)
6
Non- Ablative LASER for
Skin Rejuvenation
Pulsed-Dye Laser
• Wavelength 585 nm selectively targets
hemoglobin and melanin
• Pulse duration: 0,35 millisecond
(shorter than traditional 0,45 msec 585 PDLaser)
• Low fluence range: 2-4 J/cm2 in order to
insult but not injure the microrasculacture.
7
Pulsed – Dye Laser
Histologic Evaluation
Statistically significant increase in the production of
type III procollagen.
Hypothesis:
Endothelial cells insulted by laser, release
inflammatory mediators that trigger fibroblasts.
Clinical Evaluation
• Lack of purpura, no side effects
• Statistically significant wrinkle improvement
greater in Class II and III.
8
Non- Ablative LASER for Skin Rejuvenation
1320 nm Nd:Yag LASER
• Wavelength with significant
scattering properties.
• Approximately 20-millisecond macropulse
(train of three 300-microsecond pulses)
• Coupled with a cryogen – spray
cooling system of epidermis
• Thermal sensor built into the handpiece to
accurately document the temprature rise after
pulse and aid the physician in choosing an
optimal treatment fluence.
9
1320 nm Nd :Yag LASER
Histologic evaluation
New collagen formation in all subjects at
6 months after the fourth treatment
Clinical Evaluation
• In general terms, mild clinical improvement
and in few subjects lack of improvement
• Histologic changes are not necessarily
correlate with wrinkle reduction
• Absence or minimal side effects.
10
1450 nm Diode Laser
• Tissue scattering properties similar to 1320nm Nd: Yag
• Low-power system: longer exposures (150-250msecs)
are required to achieve sufficient fluences for selective
dermal heating
• Dynamic Cooling Device :
(pre–, intermediate-, and post-laser cryogen cooling)
• Clinical Endpoint: Small edematous papules vs
1320 nm Nd :Yag post treatment erythema.
• Clinical Evaluation: Subjective and objective wrinkle
improvement seem to be modest and comparable to
1320 nm Nd :Yag laser.
11
Advantages of
Non – Ablative LASERs
• Absence of post - operative healing period:
Ideal for the working individual
• Minimal adverse effects
• Helpful in maintaining the rejuvenating
effect of ablative laser systems
• Adjuctive method to laser treatment for
face telangiectasia and age spots
• No need for anesthesia
• No need for post - operative topical agent
administration.
12
Disadvantages Of Non – Ablative LASERs
• Definately more subtle wrinkle improvement
than those seen with ablative laser.
• Delayed clinical improvement.
(subsequent collagen deposition occurs orer a period of several months)
• Microscopic changes are not always associated with
cosmetic enhancement.
• Abseuce of improvement in skin surface texture and
dyspigmentation (midinfrared lasers)
• Multiple treatment sessions
• Higher cost than other resurfacing modalities that also
provide mild improvement such as microdermabrasion
and superficial chemical peels.
13
LASERLINE CLINICS
“Non –Ablative LASERs and complementary
techniques for skin rejuvenation”
C. Tzermias, C. Gintzou, T. Anthopoulos
• Objective:
Clinical evaluation of wrinkle improvement and
patient satisfaction using non- ablative lasers
alone and in combination with
microdermabrasion for skin rejuvenation
• Material:
Total cases: 50 / Age range 35-60 years
Skin types: I – III / Solar and age – related wrinkles
14
Methods
•All subjects were treated 3 times over a period of
12-14 weeks with non- ablative midinfrared lasers:
•1450 nm Diode laser
Fluence range: 10-14 J/Cm2
•1320 nm Nd :Yag laser
Fluence range: 28-36 J/Cm2
•Half of subjects were simultaneously submitted to
seven microdernabration facial treatments at 15 days
internal
•Clinical and photographic assessments were
recorded monthly
•Final evaluation: one month after the third laser
treatment
15
“Non–Ablative LASERs and complementary
techniques for skin rejuvenation”
Results
• Neither 1450nm Diode nor 1320nm Nd :Yag laser
induced statistically significant macroscopic wrinkle
improvement.
• Similar disappointing rates of clinical wrinkle
improvement in both groups:
Group A: Non-Ablative laser treatment alone
Group B: Non-Ablative laser combined with
microdermabrasion.
16
Results
•Considerably higher satisfaction score in
group treated with non – ablative laser
and microdermabration
•We propose the use of a complementary
minimally aggressive technique such as
microdermabrasion in order to restore a
youthful appearance to the epidermis and
increase patient satisfaction.
17
In conclusion
•Non – ablative lasers is a safe treatment,
suitable for patients with realistic
expectations and who are unwilling or unable
to undergo an ablative skin resurfacing laser
procedure.
•In combination with microdermabration can
achieve non-invasively an overall skin
improvement (clearer, smoother, brighter,
younger-appearing).
•Complementary method to vascular and
pigmented laser treatments.
18